scholarly journals FNA of misclassified primary malignant neoplasms of the thyroid: Impact on clinical management

CytoJournal ◽  
2009 ◽  
Vol 6 ◽  
pp. 1 ◽  
Author(s):  
William C. Faquin ◽  
Roberto Izquierdo ◽  
Kamal K. Khurana
Keyword(s):  
Lymph Node ◽  
Thyroid Carcinoma ◽  
Lymph Node Dissection ◽  
Clinical Management ◽  
Medullary Carcinoma ◽  
Malignant Neoplasms ◽  
Node Dissection ◽  
Histologic Diagnosis ◽  
Serum Calcitonin ◽  
Additional Surgery

Background: Fine needle aspiration (FNA) cytology is a popular, reliable and cost effective technique for the diagnosis of thyroid lesions. The aim of our study was to review cases of misclassified primary malignant neoplasms of the thyroid by FNA, and assess the causes of cytologic misdiagnosis and their impact on clinical management. Methods: Clinical data, FNA smears and follow-up surgical specimens of cases diagnosed with primary thyroid carcinoma were reviewed. Results: Of the 365 cases with a malignant diagnosis by FNA over a period of 11 years, nine (2.4 %) were identified with discrepant histologic diagnosis with regard to the type of primary thyroid malignancy. In addition, four cases were added from the consultation files of the Massachusetts General Hospital. Areas of difficulty contributing to misclassification included overlapping cytologic features (n = 6), rarity of tumors (n = 3), and sampling limitations (n = 4). Of the 13 cases, 12 underwent total or near total thyroidectomy and one patient had concurrent surgical biopsy. Measurement of serum calcitonin levels in one case, with an initial cytologic diagnosis of medullary carcinoma, prevented unnecessary lymph node dissection. Misclassification of medullary carcinoma as papillary carcinoma precluded lymph node dissection in one case. Further management decisions were based on the final histologic diagnosis and did not require additional surgery. Two cases of undifferentiated (anaplastic) thyroid carcinoma were misdiagnosed as papillary thyroid carcinoma. Both patients received total thyroidectomies, which may not otherwise have been performed. Conclusions: A small subset of primary malignant neoplasms of the thyroid may be misclassified with regard to the type of malignancy on FNA. The majority of primary malignant neoplasms diagnosed on FNA require thyroidectomy. However, initial cytologic misclassification of medullary carcinoma or undifferentiated carcinoma as other malignant neoplasms or vice versa may have an impact on clinical management.

Medullary thyroid carcinoma in children: current state of the art and future perspectives

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Andreas Kiriakopoulos ◽  
Anastasia Dimopoulou ◽  
Constantinos Nastos ◽  
Dimitra Dimopoulou ◽  
Konstantina Dimopoulou ◽  
...  
Keyword(s):  
Lymph Node ◽  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Lymph Node Dissection ◽  
Locally Advanced ◽  
Biological Behavior ◽  
Prophylactic Surgery ◽  
Node Dissection ◽  
Serum Calcitonin ◽  
Medullary Thyroid

Abstract Medullary thyroid carcinoma (MTC) is a distinct type of malignant thyroid tumor in cell origin, biological behavior, and natural history. It accounts for 1.6% of all thyroid cancers and presents either sporadically or as a hereditary disease, the latter occurring as a part of multiple endocrine neoplasia (MEN) 2A and MEN2B syndromes or as a familial MTC disease with no other manifestations. The gene responsible for the hereditary form is the rearranged during transfection (RET) gene, a proto-oncogene located to human chromosome 10. Most pediatric MTC cases have been discovered after genetic testing investigations, leading to the concept of prophylactic surgery in presymptomatic patients. Therefore, the genetic status of the child, along with serum calcitonin levels and ultrasonographic findings, determine the appropriate age for prophylactic surgical intervention. Nevertheless, a diagnosis at an early stage of MTC warrants total thyroidectomy and central lymph node dissection with the addition of lateral/contralateral lymph node dissection depending on the tumor size, ultrasonographic evidence of neck disease, or calcitonin levels. Conversely, locally advanced/unresectable or metastatic MTC is primarily treated with multikinase inhibitors, while more specific RET inhibitors are being tested in clinical trials with promising results.

Prophylactic Lymph Node Dissection in Papillary Thyroid Carcinoma: Is There a Place for Lateral Neck Dissection?

2013 ◽  
Vol 37 (7) ◽  
pp. 1584-1591 ◽  
Author(s):  
Romain Ducoudray ◽  
Christophe Trésallet ◽  
Gaelle Godiris-Petit ◽  
Frédérique Tissier ◽  
Laurence Leenhardt ◽  
...  
Keyword(s):  
Lymph Node ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Neck Dissection ◽  
Lymph Node Dissection ◽  
Lateral Neck ◽  
Papillary Thyroid ◽  
Node Dissection ◽  
Lateral Neck Dissection ◽  
Prophylactic Lymph Node Dissection

scholarly journals Should a family history of papillary thyroid carcinoma indicate more aggressive therapy in patients with this tumor?

2014 ◽  
Vol 58 (8) ◽  
pp. 812-816 ◽  
Author(s):  
Pedro Weslley Rosario ◽  
Maria Regina Calsolari
Keyword(s):  
Lymph Node ◽  
Family History ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Lymph Node Dissection ◽  
Poor Prognosis ◽  
Tumor Resection ◽  
Papillary Thyroid ◽  
Node Dissection ◽  
History Of

Objective To determine whether the currently recommended therapy for papillary thyroid carcinoma (PTC) that show no classical factors indicating a poor prognosis is also effective in cases with a family history of this tumor. Subjects and methods: Forty-two patients were studied; 10 were submitted to lobectomy and 32 to total thyroidectomy, including 23 without lymph node dissection and 9 with lymph node dissection. None of the patients received radioiodine or was maintained under TSH suppression. Results No case of recurrence was detected by imaging methods and there was no increase in thyroglobulin or antithyroglobulin antibodies during follow-up (24 to 72 months). Conclusion The treatment usually recommended for patients with PTC does not need to be modified in the presence of a family history of this tumor if no factors indicating a poor prognosis are present (tumor ≤2 cm, non-aggressive histology, no extensive extrathyroid invasion or important lymph node involvement, complete tumor resection, no evidence of persistent disease after surgery).

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